Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi

Abstract Background Exclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi. Methods The study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy. Results The district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers. Conclusions Breastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.

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Mothers’ Experience In Support Of Exclusive Breastfeeding: Scoping Review

Jurnal Kebidanan Midwiferia ◽

10.21070/midwiferia.v6i1.507 ◽

2020 ◽

Vol 6 (1) ◽

pp. 38-46

Author(s):

Nidya Comdeca Nurvitriana ◽

Atik Triratnawati ◽

Warsiti

Keyword(s):

Work Environment ◽

Exclusive Breastfeeding ◽

Urban Areas ◽

Health Workers ◽

Data Extraction ◽

World Health ◽

Breastfeeding Support ◽

Additional Food ◽

Health Organization ◽

Research Criteria

Exclusive breastfeeding is one of the important strategies to reduce child mortality which has been recommended by the World Health Organization (WHO). Exclusive breastfeeding is defined as the provision of nutritional intake to infants from the first time of birth until at least 6 months can without additional food and drinks. In 2016 WHO showed that the average level of breastfeeding worldwide was only 38% which occurred in urban areas. In the city area it was found that many breastfeeding mothers worked and obstacles and support arose. Working mothers have low trust and intention so as to increase the frequency of failure to give exclusive breastfeeding. This study aims to review support for exclusive breastfeeding. The systematic literature review covers eight stages, namely: Identifying middle frequency problems, Determining priority problems and research questions, Inclusion and Exclusion Criteria, literature search, Selecting articles, data extraction, Critical Assessment, Data collection and Mapping. Data searched from Pubmed and Onesearch. The researchers, then, examined the feasibility of finding documents. Finally, researchers found 9 documents that research criteria. Information on exclusive breastfeeding support was found from 5 journals, namely internal factors (self, family), while external factors (health workers, work environment) were found from 5 journals from 9 journals. The highest influence of support was a work environment characterized by a lack of support from facilities, coworkers, workloads of institutions that influenced the mothers' own intentions. The mother's experience of getting support from exclusive breastfeeding includes internal (self, family) and external (health worker, work environment).

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Improving Breastfeeding in Rural Tanzania Using Eight-Step Policy Analysis Methodology

Policy Politics & Nursing Practice ◽

10.1177/1527154420945306 ◽

2020 ◽

Vol 21 (4) ◽

pp. 213-221

Author(s):

Katherine Skiff ◽

Maria deValpine ◽

Andrea Knopp

Keyword(s):

Policy Analysis ◽

Exclusive Breastfeeding ◽

Newborn Care ◽

Complementary Food ◽

World Health ◽

Rural Tanzania ◽

Food Education ◽

Wide Range ◽

Health Organization ◽

Emergency Fund

Appropriate breastfeeding has the potential to have the broadest impact on childhood survival in children under 5 years compared with all other preventive interventions. The World Health Organization and United Nations International Children’s Emergency Fund recommend that all facilities providing maternal services and newborn care have a written policy addressing breastfeeding that is routinely disseminated to staff. A Mara region hospital in rural Tanzania does not have a breastfeeding policy. Collins adapted Bardach’s eightfold path for policy analysis specifically for health policies. This eight-step process was used to evaluate three promising policies to improve breastfeeding in populations in and around this hospital. These policies include exclusive breastfeeding education, complementary food education, and community health worker home visits. Analysis identified exclusive breastfeeding with adjunct complementary food education as the most feasible policies to increase breastfeeding in and around the target hospital. With improved feeding practices, chronic malnutrition rates are expected to decline in the villages that the hospital serves. This methodology can be used by nurses to develop health polices addressing a wide range of health issues in a wide variety of settings.

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Practice of skin-to-skin contact, exclusive breastfeeding and other newborn care interventions in Ethiopia following promotion by facility and community health workers: results from a prospective outcome evaluation

Acta Paediatrica ◽

10.1111/apa.13597 ◽

2016 ◽

Vol 105 (12) ◽

pp. e568-e576 ◽

Cited By ~ 6

Author(s):

Jennifer A. Callaghan-Koru ◽

Abiy Seifu Estifanos ◽

Ephrem Daniel Sheferaw ◽

Joseph de Graft-Johnson ◽

Carina Rosado ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Exclusive Breastfeeding ◽

Health Workers ◽

Newborn Care ◽

Outcome Evaluation ◽

Skin Contact ◽

Skin To Skin

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The impact of COVID-19 on the provision of respectful maternity care: findings from a global survey of health workers

10.1101/2021.05.05.21256667 ◽

2021 ◽

Author(s):

Anteneh Asefa ◽

Aline Semaan ◽

Therese Delvaux ◽

Elise Huysmans ◽

Anna Galle ◽

...

Keyword(s):

Quality Of Care ◽

Maternity Care ◽

Qualitative Data ◽

Health Workers ◽

Qualitative Content Analysis ◽

Standards Of Care ◽

Respectful Maternity Care ◽

The Impact ◽

Maternal And Newborn

Background Significant adjustments to the provision of maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care. Aim To explore how the COVID-19 pandemic affected frontline health workers' ability to provide respectful maternity care globally. Methods We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected quantitative and qualitative data between July and December 2020 and conducted a qualitative content analysis to explore open-ended responses. Findings Health workers (n=1,127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers' fear of getting infected and measures taken to minimise COVID-19 transmission. Discussion Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term. Conclusions The measures taken during the COVID-19 pandemic disrupted the quality of care provided to women during labour and childbirth generally, and respectful maternity care specifically. Keywords Maternal health; Quality of care; Labour; Childbirth; Newborn health; Intrapartum care, Antenatal care, Postnatal care

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Improving Implementation of 10 STSB (Steps to Successful Breastfeeding) through BENEFIT (Breastfeeding Exclusively in Health Facility) Intervention in East Java, Indonesia

Amerta Nutrition ◽

10.20473/amnt.v5i2sp.2021.10-18 ◽

2021 ◽

Vol 5 (2SP) ◽

pp. 10

Author(s):

Mellysa Kowara

Keyword(s):

Health Facility ◽

Exclusive Breastfeeding ◽

Post Partum ◽

Phase 1 ◽

World Health ◽

Breastfeeding Support ◽

Cross Sectional ◽

Skin Contact ◽

Management Procedures ◽

Critical Management

ABSTRAKLatar Belakang: Peningkatan cakupan ASI eksklusif dapat dilakukan dengan menerapkan 10 LMKM di fasilitas kesehatan. Berdasarkan hasil penilaian program 10 LMKM tahap 1 menunjukkan perlunya penguatan 10 LMKM terutama langkah 1 dan 2 sebagai prosedur pengelolaan kritis (Critical Management Procedural). Untuk menindaklanjuti temuan tersebut maka dijalankan Project BENEFIT untuk meningkatkan penerapan dari langkah-langkah tersebut. Proyek tersebut dilaksanakan pada tahun 2019 hingga 2020 di 5 kabupaten/kota di Jawa Timur yaitu Bondowoso, Jember, Probolinggo, Trenggalek dan Surabaya.Tujuan: Penelitian ini bertujuan untuk mengevaluasi implementasi penguatan 10 LMKM yang dilakukan melalui proyek BENEFITyang berfokus pada penguatan langkah 1 dan 2 di fasilitas kesehatan di Provinsi Jawa Timur dan bagaimana pengaruhnya terhadap penerapan langkah lainnya serta pencapaian dalam indikator menyusui. Metode: Studi crossectional dilakukan pada 720 responden yang terdiri dari 143 pimpinan fasilitas kesehatan dan 577 ibu nifas (untuk validasi data). Pengumpulan data dilakukan dengan menggunakan kuesioner yang diadaptasi dari BFHI Unicef/WHO yang mengevaluasi penerapan keseluruhan langkah dalam 10 LMKM menggunakan aplikasi KoBo ToolBox pada periode Juli-September 2020. Hasil: Terdapat peningkatan dalam penerapan 10 LMKM terutama langkah 1 dan 2. Langkah 1 yaitu tersedianya kebijakan tertulis pemberian ASI eksklusif menunjukkan peningkatan kepatuhan yang signifikan (66,4 menjadi 72,82; α= 0,015). Sedangkan untuk tahap 2 (pelatihan dukungan menyusui bagi petugas kesehatan dan non-kesehatan) menunjukkan peningkatan yang signifikan dalam pelaksanaannya (69,5 menjadi 77; α = 0,015). Prosedur manajemen kritis berperan sebagai landasan yang mempengaruhi praktik dukungan menyusui di fasilitas kesehatan. Berdasarkan hasil monitoring dan evaluasi menunjukkan adanya perbaikan pada praktik dukungan menyusui selama perawatan ibu di fasilitas kesehatan seperti cakupan IMD (71,2%) baik pada persalinan normal maupun seksio sesarea, rawat gabung (69,1%) dan praktik menyusui bayi baru lahir. (73,5%). Kesimpulan: Intervensi BENEFIT yang berfokus pada penguatan langkah 1 dan 2 dalam 10 LMKM sebagai prosedur manajemen kritis mampu meningkatkan kepatuhan implementasi keseluruhan langkah 10 LMKM. Sebagai landasan untuk melaksanakan langkah-langkah lainnya, penguatan 10 LMKM terutama langkah 1 dan 2 terbukti dapat meningkatkan praktik dukungan menyusui di fasilitas kesehatan oleh seluruh staf.Kata Kunci: Menyusui, 10 LMKM, BENEFIT ABSTRACTBackground: 10 Steps to Successful Breastfeeding (STSB) was implemented as an attempt to improve the coverage of exclusive breastfeeding in healthcare facilities. Results of the phase 1 Baby-Friendly Hospital Initiative (BFHI) assessment necessitated further strengthening for steps 1 which is the availability of an exclusive breastfeeding policy and step 2 which entails training provision for maternal and child health officer. These two steps are regarded as critical management procedures which act as a foundation for the implementation of subsequent steps. To follow up on these findings, Project BENEFIT was implemented to improve steps 1 and 2. The project was carried out between 2019 and 2020 in 5 districts in East Java, namely Bondowoso, Jember, Probolinggo, Trenggalek and Surabaya. Objectives: This objective of this study is to evaluate the implementation of the BENEFIT project and how it affects the implementation of other steps as well as how it impacts breastfeeding indicators.Methods: This cross-sectional study was conducted on 720 respondents consisting of 143 health facility leaders and 577 post-partum mothers to validate response. Data was collected using a questionnaire adapted from Baby Friendly Hospital Initiation (BFHI) guidelines by World Health organization (WHO) and United Nations Children Emergency Fund (UNICEF) using the KoBo ToolBox application between July and October 2020. Results: There was an improvement in the implementation of steps 1 and 2. A significant increase in compliance was found for Step 1 (66.4 to 72.82 α = 0.015) and step 2 (69.5 to 77.9, α = 0.15). Subsequent monitoring and evaluation also showed moderate improvement on breastfeeding support practice in health facilities such as coverage of skin-to-skin contact (71.2%) both on normal and section-caesarean delivery, rooming-in (69.1%) and the practice of breastfeeding newborn (73.5 %). Conclusion: The BENEFIT project assisted in the increased compliance for steps 1 and 2 STSB, which further improved breastfeeding support practices by all healthcare facility staff members for other steps. Keywords: Breastfeeding, 10 STSB, BENEFIT

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Comparing breastfeeding experiences between mothers spending the traditional Chinese confinement period in a confinement centre and those staying at home: a cohort study

10.21203/rs.3.rs-26168/v4 ◽

2020 ◽

Author(s):

Siew Cheng Foong ◽

May Loong Tan ◽

Wai Cheng Foong ◽

Jacqueline J Ho ◽

Fairuz Fadzilah Rahim

Keyword(s):

Logistic Regression ◽

Breast Milk ◽

Support Groups ◽

Exclusive Breastfeeding ◽

World Health ◽

Multiple Logistic Regression ◽

Breastfeeding Support ◽

Ethnic Chinese ◽

Chinese Mothers ◽

Breastfeeding Rates

Abstract BackgroundEthnic Chinese mothers in Malaysia adhere to 30 days of traditional postpartum practices (the “confinement period”) aimed at recuperation after delivery. Recently there has been an emergence of confinement centres (CCs) where mothers stay and receive traditional confinement care. Ethnic Chinese mothers have low breastfeeding rates. There are concerns that practices in CCs could contribute to this but no data exists. We described mother’s breastfeeding experience at CCs and identify areas for potential improvement in breastfeeding support.MethodsEthnic Chinese mothers intending to breastfeed their healthy infants were recruited post-delivery between August and October 2017 then, at 1 and 6 months, were telephone interviewed about their experience. For every participant going to a CC, another mother going home was recruited.Chi-square test was used to compare groups and multiple logistic regression was used to assess the effect of confinement place on exclusive breastfeeding. We defined exclusive breastfeeding according to the World Health Organisation’s definition which means no other food or drink, not even water, except breast milk (including milk expressed or from a donor).Results Of 187 mothers, 88(47%) went to CCs. Significantly more were primipara and fewer had previous breastfeeding experience. Response rates for the 1- and 6- month interviews were 88%(CC) versus 97%(home); and 77%(CC) versus 87%(home).Exclusive breastfeeding rates were similar between the groups: 62%(CC) versus 56%(home) at 1 month (p=0.4); and 37%(CC) versus 42%(home) at 6 months (p=0.5). Multiple logistic regression did not show that CCs were a factor affecting exclusive breastfeeding rates at 1 month, (adjusted odds ratio(aOR) 1.7, 95% confidence interval(CI) 0.9, 3.3), or 6 months (aOR 0.9, 95% CI 0.4, 1.7). However, significantly more CC participants only fed expressed breast milk. Despite 66% of CC participants reporting that their centre supported breastfeeding, only 6(8%) CC participants compared to 66(69%) of home participants slept with their baby (p<0.001). The proportion encountering breastfeeding difficulties were similar between groups. CC participants sought help for breastfeeding problems mainly from CC staff and support groups while home participants obtained help from friends and healthcare professionals.ConclusionBreastfeeding rates appeared to be similar at CCs and home but there were gaps in how CCs supported breastfeeding. Targeted training to CC staff to support breastfeeding may result in better outcomes for mothers staying in CCs.

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Analysis of Mother Behavior Factor in Following Program of Breastfeeding Support Group in the Region of Asemrowo Health Center, Surabaya

NurseLine Journal ◽

10.19184/nlj.v4i2.11515 ◽

2020 ◽

Vol 4 (2) ◽

pp. 94

Author(s):

Esti Yunitasari ◽

Alfiani Triningsih ◽

Retnayu Pradanie

Keyword(s):

Health Center ◽

Support Group ◽

Exclusive Breastfeeding ◽

Health Workers ◽

Rank Correlation ◽

Validity And Reliability ◽

Breastfeeding Support ◽

Cross Sectional ◽

Significance Level ◽

And Behavior

Breastfeeding support group is an activity consisting of 6-12 people mother with infants aged 0-6 months gathered regularly 2 weeks. Mothers can get support from people who are experiencing the same situation. Because members of this program have similar experiences and environmental situations, a mutually supportive atmosphere will be more easily established. However this program has not been implemented maximally in some areas including Asemrowo Health Center,, which resulted in exclusive breastfeeding coverage in Asemrowo sub-district has not reached the national target that only 58.22%. This study aims to determine the factors associated with maternal behavior in following the breastfeeding support group in the region of Asemrowo health center, Surabaya. This was cross sectional design. The populations were 64 mothers who have an infant in 0-6 month at the region of Asemrowo Health Center, Surabaya using total sampling technique. There were five variables in this study, there are knowledge, attitude, belief, culture as independent variable and behavior as dependent variable. The instrument used a modified questionnaire from previous research and tested validity and reliability with validity results of 0.350-0.916 and reliability of 0.663 for knowledge questionnaires, 0.723 attitude questionnaires, 0.632 belief questionnaires, 0.863 cultural questionnaires, and 0.948 behavior questionnaires. Data analyze using spearman rank correlation with significance level α≤0,05. Statistical test result p= 0.00 r= 0,457 for knowledge with behavior, p= 0.011 r= 0,315 for attitude and behavior, p= 0,035 r= 0,264 for belief and behavior, p= 0.003 r= 0,360 for culture and behavior. The result had showed that was correlation between knowledge with behavior, attitude with behavior, belief with behavior and culture with behavior. Provision of health counseling and promotion by health workers on the importance of participating in Breastfeeding support group program to mothers with infants aged 0-6 months is needed so that mothers can provide exclusive breastfeeding.

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The Impact of the World Health Organization Essential Newborn Package on Newborn Care Practices and Survival Rates in Sub-Saharan Africa: A Systematic Literature Review

International Journal of Childbirth ◽

10.1891/2156-5287.9.1.19 ◽

2019 ◽

Vol 9 (1) ◽

pp. 19-29

Author(s):

Andy Emmanuel ◽

Victoria Kain ◽

Elizabeth Forster

Keyword(s):

Systematic Review ◽

Health Workers ◽

Newborn Care ◽

Sub Saharan Africa ◽

World Health ◽

Essential Newborn Care ◽

The World ◽

Sub Saharan ◽

Health Organization ◽

The Impact

Sub-Saharan Africa, has the highest child mortality rate in the world (World Health Organization [WHO], 2016). However, there is a paucity of current systematic reviews on the impact of essential newborn care interventions in Africa. Therefore, the aim of this systematic review was to summarize evidence about the impact of essential newborn care interventions in Africa. Numerous databases were searched to retrieve articles that reported interventions in newborn care in Africa. The search was limited to the English language and to articles published between 2007 and 2017. Nine articles were selected for inclusion in this systematic review. Overall, these papers demonstrated an increase in performance of health workers (between 8 and 400%) following a test of knowledge, while health workers practical performance increased by 34%. Moreover, neonatal mortality was reduced by 45%, while perinatal mortality was reduced by 30%. Training healthcare workers is one of the most effective ways of improving newborn care and neonatal survival in Africa. However, there is a need for additional evidence to support this, because none of the reviewed studies assessed the impact of training by examining variables such as trainees' satisfaction with training, the knowledge and skills developed, and the health outcomes achieved.

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VIDEO-BASED INTERVENTION ON THE KNOWLEDGE OF BREAST-MILK SUPPORT GROUP IN SEMBUBUK VILLAGE, MUARO JAMBI REGENCY: A PRE-EXPERIMENT STUDY

NSC Nursing ◽

10.32549/opi-nsc-60 ◽

2021 ◽

pp. 28-45

Author(s):

Yuli Suryanti ◽

Damris Muhammad ◽

M.Naswir M.Naswir ◽

Guspianto Guspianto

Keyword(s):

Breast Milk ◽

Support Groups ◽

Support Group ◽

Exclusive Breastfeeding ◽

Infant Health ◽

Health Workers ◽

Wilcoxon Test ◽

P Value ◽

Breastfeeding Support ◽

The One

Introduction: Breast milk is the best food for babies because it contains nutrients to support growth and development. The achievement rate of exclusive breastfeeding in ASIA countries has not yet reached the expected target. The coverage of exclusive breastfeeding in Jambi Province in 2018 was 59.36%. The success of exclusive breastfeeding is not only influenced by the mother's physical and mental readiness to breastfeed. Still, it is also influenced by support from health workers and the family. The study aimed to determine the effect of counseling using breastfeeding video on grandmothers' knowledge as breastfeeding support in Sembubuk Village, Muaro Jambi Regency. Methods: This type of pre-experimental research using the One Group Pretest-Posttest design, which saw 40 grandmothers of the Breast Milk Support Group members, was carried out from June 2020 to July 2021. Respondents answer the questionnaires to complete the data collection. The intervention carried out in this study was the provision of counseling using video media about breastfeeding. Data were analyzed through univariate and bivariate using the Wilcoxon test. Results: The results showed the p-value = 0.0001, which means that breastfeeding video affects grandmothers' knowledge in breastfeeding support groups in Sembubuk village, Muaro Jambi District. Conslusion: The results of this study are expected to increase public knowledge and insight regarding the importance of breastfeeding for infant health so that positive behavior is formed in breastfeeding, providing additional appropriate information to advance understanding of breastfeeding support groups about breastfeeding. Keywords: Exclusive breastfeeding, health education, Knowledge, Video-based

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DETERMINANTS OF BREASTFEEDING EXCLUSIVE IN THE WORKING AREA OF RUMBIA HEALTH CENTER, BOMBANA REGENCY: A CROSS SECTIONAL STUDY

NSC Nursing ◽

10.32549/opi-nsc-53 ◽

2021 ◽

pp. 1-19

Author(s):

Asnidawati Asnidawati ◽

Wa Ode Salma ◽

Adius Kusnan

Keyword(s):

Health Center ◽

Family Support ◽

Exclusive Breastfeeding ◽

Health Workers ◽

Cross Sectional Study ◽

World Health ◽

P Value ◽

Cross Sectional ◽

Significance Level ◽

Health Organization

Background: Breast’s milk is an excellent food for the growth and development of infants. The United Nations Children's Funds (UNICEF) and the World Health Organization (WHO) recommend that children only be exclusively breastfed for six months and continued until two years. This study analyzes the effect of family support, health workers, and socio-culture on exclusive breastfeeding in the working area of the Rumbia Health Center, Rumbia District, Bombana Regency. Methods: This study involved 86 mothers who had babies aged 0-6 months who were registered and domiciled in the working area of the Rumbia Health Center spread over 4 Kelurahan and 1 Village, which were selected by purposive sampling using a cross-sectional design from February to April 2021. Data analysis using odds ratio (OR) and logistic regression at significance level < 0.05. Results: The largest age group in the range of 20-35 years, as many as 68 people (79.1%), undergraduate as many as 32 people (37.2%), and income above Rp. 2.552.014, - / month as many as 60 people (69.8%). The results showed an effect of family support on exclusive breastfeeding (p = 0.002<0.05). There is no influence of socio-cultural factors on exclusive breastfeeding (p = 0.282>0.05) and the results of multivariate analysis of the most dominant variables associated with exclusive breastfeeding in the working area of Rumbia Health Center District Rumbia Bombana Regency is supported by health workers with an OR = 9.199 (p-value = 0.039<0.05). Conclusions: This study concludes that the support of health workers plays a very important role in exclusive breastfeeding to infants aged six months, which can impact improving the health of toddlers. Keywords: Determinant, breastfeeding exclusive, toddler, mother

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